Table 3

3-150 Evolution of TMD: clinical signs 1887–1983

Author and YearSigns
     The pre-Costen era
Annandale T 188717 Joint sounds, reduced jaw opening
Lanz W 190918 Inefficient chewing, TMJ pain produced by palpation
Summa R 191819 Receding chin with short mandible
Pringle J 191820 Malocclusion
Wright WH 192021 After bite opening, test for improved hearing using whispered voice, watch, tuning fork
Monson GS 192122 Measure facial dimension from base of nose to tip of chin, examine for facial sagging and short upper lip, detect for condylar backward thrust or slippage by placing small fingers in ear canals, check for defective swallowing
Decker JC 192523 Measure face from anterior nares to symphysis of chin, check hearing using whispered voice and tuning fork tests, examine ear canals for narrowing and intrusion of condyles, palpate inside ear canals with fingers for “clicks” during jaw movements, palpate TMJs for “grinding and crackling,” examine tympanic membranes for thickening or dullness
Wakeley C 192924 “Clicking and crackling” of TMJ
Goodfriend W 193325 Facial measurements, palpate condylar movements
     The post-Costen era
Costen JB 19341 Examine for: overbite, lateral bite slippage, missing teeth, poorly fitting dentures, deformed mandible, mandibular condyle dislocation, nystagmus, herpes zoster in ear or mouth, xerostomia, sialorrhoea; search for TMJ pain during joint palpation; hearing is tested by conversational voice or whisper
Seaver UP 193727 Palpate for excessive excursion of condylar head as well as crepitus and tenderness with and without dentures, examine for lateral deviations of mandible during jaw opening
Schopper AF 193830 Examine for worn teeth from tobacco chewing or bruxism, inspect for facial asymmetry, make facial measurements to rule out receding condyle, examine masticatory muscles for unilateral hypertrophy accompanied by contralateral atrophy
Dingman RO 194032 Auscultate TMJ sounds, check for difficulties in mastication and phonation
Block LS 194733 while patient clenches teeth, place fingers in external auditory canal using downward and forward pressure to detect deviations and erratic movements
Kiehn CL 195234 Auscultate for TMJ crepitus, palpate for meniscus slippage under local anesthetic
Schwartz LL 1955,19565 6 Palpate for muscle pain and spasm in muscles of mastication as well as in the posterior cervical, trapezius, and other nearby muscles
  • 3-150 Table 3 is intended only to demonstrate general evolutionary trends of TMD signs and may not cite all authors who originally described them. Some of these authors disagreed with the specificity of the signs listed.